"When fascism comes to America, it will be wrapped in the flag and carrying the cross."
-- Sinclair Lewis

Thursday, July 23, 2015

Jeb! Admits He Wants To "Phase Out" Medicare... Bernie Has A Different Approach

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Yesterday I was released from the hospital after a successful stem cell transplant meant to keep me in remission after 9 months of cancer treatment. Science saved me. City of Hope saved me. Dr. Budde saved me. Jesus saved me. The love and support from my friends and family and neighbors saved me. And Medicare paid for it. I can't imagine what would have happened to me without Medicare. The bills were beyond comprehension. But maybe imagining what we would do without Medicare is something worth contemplating. After all, Trump isn't going to win the Republican presidential nomination. And there's a good chance Jeb! Bush will. And he-- like generations of elite Republicans before him-- wants to end Medicare."I think," Bush told a Koch brothers event in New Hampshire this week, "a lot of people recognize that we need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits. But that we need to figure out a way to phase out this program for others and move to a new system that allows them to have something-- because they’re not going to have anything." He admits-- at least for the sake of the primary-- that he's all for the Paul Ryan proposals to privatize Medicare. Happy 50th anniversary, Medicare, from another hereditary Bush millionaire with no comprehension of working families! "Remember," Steve Benen writes at the above link, "Jeb Bush is the ostensible moderate candidate in the massive GOP presidential field. It says something important about Republican politics in 2015 when the most mainstream candidate is also the candidate who wants to scrap Medicare altogether."

Regardless, there’s quite a bit wrong with his take on the issue, both as a matter of politics and policy. Let’s start with the former.The Florida Republican is convinced that “people understand” the need to get rid of Medicare. He’s mistaken. Given the polling from the last several years, what people understand is that Medicare is a popular and successful program, and a pillar of modern American life.Previous attempts to “phase out” the program have met with widespread public scorn and if Jeb Bush believes he can “persuade people” to get rid of Medicare, he’s likely to be disappointed.As for the policy, there’s no point in denying that the Medicare system faces long-term fiscal challenges, but to argue, as Jeb Bush does, that Democrats have ignored the conversation is plainly incorrect. On the contrary, while Republicans fight to eliminate the Medicare program, Democrats have had great success in strengthening Medicare finances and extending its fiscal health for many years to come.The secret, apparently, was passing the Affordable Care Act.Before “Obamacare” was passed, Medicare was projected to face a serious fiscal shortfall in 2017. As of yesterday, Medicare trustees now believe the system is fiscally secure through 2030.Kevin Drum noted the slowdown in costs, which is “spectacularly good news.”

Ten years ago, Medicare was a runaway freight train. Spending was projected to increase indefinitely, rising to 13 percent of GDP by 2080. This year, spending is projected to slow down around 2040, and reaches only 6 percent of GDP by 2090.Six percent! That’s half what we thought a mere decade ago. If that isn’t spectacular, I don’t know what is.

Obviously, all of these projections come with caveats because no one can say with certainty what will happen in the future, but the projections are encouraging-- and far more heartening than they were before the ACA passed.But Jeb Bush is under the impression that Medicare is, without a doubt, doomed, so we might as well get rid of the program now and see what Paul Ryan has in store for seniors in his far-right bag of tricks.There’s a better way. Medicare’s future is looking brighter, it’s as popular as ever, and its fiscal challenges can be addressed without tearing down the entire system. It’s a matter of political will-- either elected policymakers will fight to protect Medicare or they’ll push to eliminate it.

Jeb! says Democrats need to join the debate. Democrats have-- first by inventing and passing Medicare and now by pushing Medicare-for-all proposals. Bernie Sanders, the tip of the spear on Democratic Party policy, whether he wins or loses, cited Richard Eskow's rationale for going all in on Medicare: "Medicare For All is an urgently-needed next step, leading to a more humane and efficient health care system. Here are five reasons why."

•“Health insurance” is not the same thing as “health care.”Many people use the two terms interchangeably, but they are not the same thing. “Health care” is a phrase which has traditionally referred to medical treatment. It’s what happens what a medical professional provides care to someone who needs it, or when a medication or medical device is provided to a patient. Health insurance is a financial arrangement that collects funds to pay for medical treatment. The majority of Americans covered by private health insurance obtain it through for-profit corporations. Those corporations charge a significant percentage for profit and overhead.The ACA has extended health insurance to many more Americans, which is a good thing. But the problem is this: Even when they have health insurance, Americans are paying more and more every year for their actual treatment.•Insured people are paying more and more for their health care.Out-of-pocket costs of health care-- including copayments, deductibles, and benefit limits-- are soaring for people with insurance.This is a terrible financial burden for middle class families. Milliman, one of the nation’s most respected actuarial firms, issues an annual report on the cost of health care. Its most recent report found that the employee’s total cost of care increased by roughly 43 percent between 2010 and 2015. (Employer costs increased by nearly one-third.)Milliman found that the average American family with “good” employer coverage pays $10,473 per year for its medical care. That includes payroll deductions for insurance premiums, as well as out-of-pocket costs.Some households will pay less, of course, and some households will pay more. But that is an unsupportable expense for working families, especially after decades of wage stagnation.What’s more, it’s unnecessary.•For-profit health insurance is expensive and inefficient.The United States is the only developed nation in the world that relies on private health insurers to deliver a substantial portion of its health care services. Not coincidentally, we also spend significantly more for health care than any other developed nation.Health insurance profits are an enormous burden on the economy. One health insurer alone, UnitedHealthcare, reported profits of more than $10 billion in 2014. The average per-person cost of healthcare in the United States is $9,146 per person. The profits of this one corporation alone could therefore provide medical coverage to more than one million people, even at our country’s excessive rates.That is an unacceptable-- and unnecessary-- price to pay.Despite the fact that our nation spends more on health care, Americans are getting less than most other nations for their money. More Americans are uninsured, even after the inception of the Affordable Care Act, and Americans pay more on an individual basis for their care than their peers in other countries. Life expectancy is lower, and infant mortality figures are higher.The evidence is in: Private health insurance costs more, and delivers less, than government-sponsored care.•There is no “free market” in health care.Despite what many conservatives claim, there is little to no “free market” in health insurance. Most health insurance markets could be deemed “highly concentrated” under Justice Department headlines, according to a 2009 study, which means there is little or no genuine competition. Trends in mergers and acquisitions are likely to make this problem even worse.Under a profit-based system, too many participants in health care have the wrong economic incentives. The profit motive increasingly dominates all aspects of our nation’s health economy. For-profit pharmacy corporations, hospital chains, and provider practice groups are driving up costs in a system that provides an incentive to overcharge and overtreat patients. Highly leveraged acquisitions can place medical corporation executives under tremendous pressure to meet ambitious profit goals, a situation which has even led to insurance fraud.This pattern leads to a spiral of increasing health care costs. While health care inflation has slowed somewhat in recent years, costs are likely to remain significantly higher in this country until we implement a more rational and humane system.•Government can and does manage healthcare delivery efficiently.Medicare operates at lower overhead than private health insurance. Medical costs have increased more slowly for Medicare than they have for private insurance. And the rest of the developed world, which provides healthcare (either directly or indirectly) through government, pays significantly less than we do for medical care.Government can use its buying power to obtain better and more cost-effective agreements with pharmaceutical companies, medical equipment manufacturers, and other suppliers. Efficiencies of scale mean less money is spent on overhead.Best of all, there is no need to layer in a large percentage for profits, some of which go to multi-million-dollar executive salaries.It is time to join the rest of the developed world in recognizing that health care is a fundamental right.

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